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What can you say to a patient on the verge of tears?

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Apologies if this is too downbeat, but there was something in the water last week. And it must have been bromocriptine, because the milk of human kindness was in vanishingly short supply.

Every other patient seemed to be on the verge of tears, and there was a sad inventiveness in the ways their misery had been brought about.

A single mother had had her windows broken after she’d asked a neighbor to stop smoking cannabis around her asthmatic children. Another mother’s partner had described to their mutual friends how ‘disgusting’ her episiotomy scar was – a wound incurred whilst bringing his child into existence, as if that had any bearing on his treatment of her. Then there was the usual stream of child protection conferences, and an alleged assault or two, plus cyberbullying, and old-fashioned bullying, in fairly equal measure.

It’s an interesting debate how much of this is the GP’s job, and how much we can really do to help, but clearly a lot of unhappy people have exhausted their other options.

It’s difficult to know what to suggest when presented with this kind of thing, when you have ten minutes to say something sensible before the next patient is due. One of the lessons of a medical career is that the human condition doesn’t lack opportunities for suffering. The problems those patients brought to me are, on a global scale, fairly trivial. But these are people whose health and happiness are being destroyed, for no better reason than that somebody else felt like hurting them.

Driving home on Friday evening, it struck me how wonderful it would be if they all took a day off. If all the bullies and abusers stopped trashing people’s homes and mocking their partners, and just did something else instead.

Perhaps they could stop texting hatred to each other, and just have a lie-in. Maybe one day they could read some Larkin, and realise that we are all vulnerable. That the people around them matter. That we should be careful of each other, we should be kind, while there is still time.

Dr Nick Ramscar is a GP in Bracknell, Berkshire

Readers' comments (14)

  • What can you say to a patient on the verge of tears?

    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

    How about.

    'Here's £5, go and tell someone who cares'

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  • So... what do you say??

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  • You could offer a tissue, assure your patient that you understand what s/he's told you & feel concern, then, if you can't dispense any practical advice, spend the rest of your 8 minutes on trying to help your patient focus on what reserves & resources s/he has to help him/her survive the situation. We can't choose what happens to us but to some extent, we can choose how to react to it. It sometimes helps a person to be reminded of that.

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  • With regards to the £5 comment above, here's hoping you don't ever need anyone to talk to in a crisis eh?

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  • Next..............................

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  • As a practice manager I have sat with patients to discuss what was initially disgruntlment with our reception/a doctor/nursing home/district nurse. It often turns into a chat, steered by the patient, about what has been going on in their lives - losing a business, loved one, worrying about children. It's rarely resolved, most people just need the outlet. I'm not a counsellor, but have sat down with my fair share of tearful patients. Clearly there is no time for this in a 10 or 15 minute consultation, I don't know the easy answer. I do agree with the comment above that "we can choose how to react to it". Sometimes reassurance that people can or are doing the right thing is all they need. Listen, reassure, and if you say you'll do something, make sure you'll do it. If you can't do anything, be honest and say so. And if you can't do it in 10 minutes, get them to come back when you have got time. I know you're all busy, but it means the world that someone cares - you might be the only one they can turn to.

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  • Maggie Thatcher banned spine transplants in the 1980's Im afraid..............................

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  • As a minimum, in 10 minutes, it should be possible to listen, be sympathetic, communicate a little warmth or empathy, make it clear you understand, and show concern... if nothing else. Pretty much what you'd hope any kind human being would do.

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  • Clearly if these people are coming to you to discuss such issues (which are really about their psychology and state of mind, and perhaps they feel there is nobody else they can speak to like a friend or relative), perhaps offering to refer them to the local psychological or counselling services? Some people may not respond well to that, but it's entirely possible that some patients would welcome the opportunity to speak confidentially to someone who has the time and expertise to really help.

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  • Am I missing the point here? It seems to me Dr Ramscar's question is entirely rhetorical!
    You all seem tremendously literally minded in offering advice but I read this as a sad comment on modern society rather than plea for help!

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